Showing posts with label global health. Show all posts
Showing posts with label global health. Show all posts

Tuesday, August 18, 2015

Global Health Rotations for Residents: Just How Good Are They?

By: Lewis First, MD, MS; Editor-in-Chief       

      The rising interest in global health rotations for trainees seems to be spreading across residency training programs as resident applicants ask more and more about what training programs are doing to train future pediatricians to recognize the importance of helping and advocating for children worldwide.  Yet how similar are the various global health programs that are ongoing in residency?  Are they similar to each other or better yet, are they based on any valid and reliable curriculum for training in global health education?   
     Butteris et al. (doi: 10.1542/peds.2015-0792) collected data from US residency programs in 2013-14 and compared and contrasted training programs that did and did not have a global health track while also looking at variations in these tracks by size of program.  The fact that 99.5% of all programs responded to this survey is impressive and speaks to the rising import of this topic in training future pediatricians. The authors noted those programs that had a track and if not, a faculty leader, and/or field experiences both internationally and domestically.   
     Just how consistent or inconsistent these various global health education offerings are makes for interesting reading and learning from this article. If you want even more perspective on where global health training for residents is going, travel over to the commentary by Dr. Gordon Schutze (doi: 10.1542/peds.2015-1820), who is an expert on global health issues in children to learn even more. 
     Hopefully this study and accompanying commentary will serve as the nidus for collaboration across programs to find the best practices for global health education and in turn lead to more reliable and valid criteria for what a global health curriculum and training experience should consist of.

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Friday, July 17, 2015

A Farewell To Arms: The Concerns of Working with War Affected Youth In Sierra Leone

By: Joann Schulte  DO, MPH; Editorial Board Member  

       Familiarity with Sierra Leone has become commonplace over the past year, sadly due to the I Ebola epidemic in West Africa.   The cases are slowing to a trickle now with 25 new cases in Sierra Leone in the week ending July 8.  The cumulative total is 13,155 cases and 3,940 deaths in this
Country1.
      Even before Ebola arrived, Sierra Leone was a troubled country, fighting an 11-year civil war that killed an estimated 50,000 people.  That war was infamous for the use of child soldiers and sexual abuse of women and girls.  The civil war ended in 2002, and a new study published this month in Pediatrics by Betancourt et al.  (doi: 10.1542/peds.2014-1521) tracks  the outcomes of 529 war-affected youth who were ages 10 to 17 years when the war ended. About a fourth of the participants were girls. The investigators’  goals were to track outcomes  in these individuals and also identify areas where targeted interventions might do the most good.
     The study’s authors at Harvard University focused on internalizing and externalizing behaviors and the outcomes of participants as of  2008.  Internalizing behavior focus negative and inward; depression and anxiety are examples.  Externalizing behaviors focus on the outside world; hostility and aggression are examples.
      The researchers interviewed participants in 2002, just as the civil war was ending, and in 2004 and 2008. They did modeling to determine whether internal or external behaviors might be associated with better outcomes in 2008.  They found a significant association between internalization behaviors in 2004 and outcomes in 2008, such as post-traumatic stress and social attitudes and behavior.
     The authors suggested that working with war-affected youth by implementing programs to reduce anxiety and depression in survivors is an opportunity to improve their future lives and help them deal with the challenging environment in Sierra Leone.  They suggested that low-cost, group therapy that deals with trauma experienced in war might be a way forward.
     The study was done in a resource poor country, but the message about how internalization behaviors like depression and anxiety can shape future behavior is important.  In the United States, we see the impact of war on returning veterans from the Middle East with high rates of suicide.
      Maybe the Civil War Union General William T. Sherman said it best.  His 1880 speech in Ohio included the phrase “War is hell.” 2 And for survivors, the aftermath can be hell too.   Work like that done by these Harvard researchers is important in helping war-torn survivors live better lives.

1.  World Health Organization.  Ebola Situation Report - 8 July 2015.   http://apps.who.int/ebola/current-situation/ebola-situation-report-8-july-2015

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